BILL ANALYSIS �
AB 1759
Page 1
ASSEMBLY THIRD READING
AB 1759 (Pan and Skinner)
As Amended May 23, 2014
Majority vote
HEALTH 19-0 APPROPRIATIONS 12-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bocanegra, |
| |Ammiano, Rendon, Bonilla, | |Bradford, |
| |Bonta, Ch�vez, Chesbro, | |Ian Calderon, Campos, |
| |Gomez, Gonzalez, | |Eggman, Gomez, Holden, |
| |Roger Hern�ndez, | |Pan, Quirk, |
| |Lowenthal, Mansoor, | |Ridley-Thomas, Weber |
| |Nazarian, Waldron, | | |
| |Patterson, Ridley-Thomas, | | |
| |Wagner, Wieckowski | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requests the University of California (UC) to conduct
an annual independent assessment of rates, access to care and
the quality of care in the Medi-Cal program and establishes an
advisory commission to provide input to UC with appointments
made by the Governor, Speaker of the Assembly, and the Senate
Rules Committee.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Costs to UC of $900,000 General Fund for staff and consulting
services to annually assess the adequacy of Medi-Cal rates.
2)Unknown, significant General Fund cost pressure on Medi-Cal
rates, to the extent the state-sanctioned assessment conducted
pursuant to this bill finds rates should be increased.
COMMENTS : According to the author, a challenge facing the
Medi-Cal program is that the state's Medi-Cal provider
reimbursement rate setting process is neither data driven nor
evidence-based. The author argues there is no systematic
evaluation process to ensure that Medi-Cal reimbursement rates
are sufficient to ensure adequate access to care and quality of
care. Medi-Cal requires a systematic, data-driven, and
AB 1759
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evidence-based process to establish Medi-Cal rates and determine
their impact on access and quality and to ensure responsible
stewardship of taxpayer dollars.
Medi-Cal reimbursement rates are among the lowest Medicaid rates
in the nation. According to the California Budget Project,
California's Medicaid payments to physicians in 2012 were the
third lowest in the nation. California spends over 30% less per
Medi-Cal beneficiary than the national average and the least per
beneficiary among the ten largest states. Medi-Cal payments
frequently do not cover the costs of care delivery. Low
reimbursement rates can discourage providers from accepting new
Medi-Cal patients. According to a recent study, only 57% of
office-based physicians in California accept new Medi-Cal
patients, the second lowest rate in the nation. Consequently,
many Medi-Cal patients do not have timely access to a primary
care provider.
The federal Patient Protection and Affordable Care Act (ACA)
significantly expanded Medicaid program eligibility to include
individuals up earning up to 138% of the federal poverty level.
There is serious concern among interest groups, however, about
access to care and quality of care for the 8.5 million
Californians currently enrolled in the program, as well as the
additional one to two million Californians now newly eligible
under ACA provisions
The Medicare program has an independent entity conducting
systematic evaluations of the Medicare program. The Medicare
Payment Advisory Committee is an independent board of Medicare
experts that advises Congress on Medicare policy. The authors
have chosen UC to support the state's Medi-Cal policy
development. UC is already involved in conducting research for
state government, in particular the California Health Benefit
Review Program, which evaluates health insurance mandates.
Various partnerships between state Medicaid programs and state
universities already exist in approximately 14 states, including
in California. In California, this partnership is directed by
UC's California Medicaid Research Institute, which has a record
of collaboration with DHCS.
Supporters argue there is no formal systematic process to ensure
that Medi-Cal reimbursement rates are sufficient to ensure
access to care and quality of care. This bill would provide the
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Legislature with an annual assessment of Medi-Cal provider
reimbursement rates and their impact on access and quality of
care. Supporters conclude this would establish stronger
oversight of provider rates and will help to ensure access to
quality health care for California's most vulnerable
individuals.
There is no known opposition to this bill.
Analysis Prepared by : Roger Dunstan and Edward Sheen/ HEALTH
/ (916) 319-2097
FN: 0003763